PROJECT ABSTRACT This is a K23 career development award proposal from Ashley Rosko, MD, an Assistant Professor in the Division of Hematology at The Ohio State University. The K23 mentored research award will be used to assist Dr. Rosko in becoming an independently funded investigator to conduct research to improve treatment health outcomes of older adults with hematologic malignancy. Dr. Rosko has a diverse mentoring team with a proven track record, including Dr. John C. Byrd (translational science), Dr. Electra Paskett (population health), and Dr. Michelle Naughton (outcomes assessment and behavioral science). Together this mentoring team will advise and support Dr. Rosko in her research aims and career development plan. Dr. Rosko's career development plan includes formal coursework to further her knowledge of aging, research methods and biostatistics, as well as professional development activities to increase networking, paper and grant writing skills. Dr. Rosko's research interests are in identifying occult geriatric factors that affect clinical outcomes in adults with hematologic malignancy in order to develop effective interventions to improve survival and quality of life. Her research plan will test baseline fitness metrics with an intervention of a structured exercise program, combined with select aging biomarkers, to assess changes in physiologic fitness among patients with hematologic malignancies awaiting bone marrow transplant. Maintaining physical function is an important part of cancer care. Patients with hematologic malignancy are prone to deconditioning due to the toxicities associated with treatment and bone marrow transplant. Exercise programs are a proven intervention to prevent functional decline and improve quality of life, but are underutilized in patients with hematologic malignancy. Deconditioning is associated with serious adverse consequences, such as falls, which are common and dangerous in this patient population. Thus, the objective of the research project is to complete a feasibility study implementing a structured exercise program, the Otago Exercise Program (OEP), to improve physical fitness in pre-transplant patients with hematologic malignancies. The central hypothesis is that the OEP can be implemented safely and successfully in patients with hematologic malignancies awaiting transplant. The rationale is that structured exercise programs can improve outcomes in cancer patients, but feasibility, practicality and disease/treatment characteristics can be barriers to implementation, and need to be evaluated first. The work accomplished here will provide preliminary data regarding the safe implementation of the OEP and feasibility of recruitment, data collection, and patient adherence. Data obtained from this study will be used to apply for an R21 grant to support a randomized clinical trial to prevent physical decline and improve health and quality of life outcomes in adults with hematologic malignancy.